Arya M. Sharma, MD

Chair, Obesity Research and Management, University of Alberta

In 2002, Arya M. Sharma was recruited from the Humboldt University, Berlin, Germany, to a Canada Research Chair (Tier1) in Cardiovascular Obesity and Management at McMaster University. In 2007 he accepted a position as Professor and Chair in Obesity Research and Management at the University of Alberta, where he is also the Medical Director of the Provincial Bariatric Program. In 2006, he spearheaded the launch of the Canadian Obesity Network, which, with almost 10,000 members, has remarkably transformed the landscape of obesity research and management in Canada. He is currently also President of the Canadian Association of Bariatric Physicians and Surgeons. His research focuses on an evidence-based approach to managing obese patients and includes the development of the Edmonton Obesity Staging System. Dr. Sharma has authored or coauthored more than 300 publications and has lectured widely on the aetiology and management of hypertension, obesity, and related cardiometabolic disorders. Dr. Sharma is regularly featured as a medical expert in national and international TV and print media including the CBC, CTV, New York Times, and MSNBC. Dr. Sharma maintains a widely-read blog where he regularly posts his ideas and thoughts on obesity prevention and management: http://www.drsharma.ca.

That we have a widespread anti-fat bias and discrimination out there is no secret. But when this comes from the very people who should be there to provide help and support to those struggling with excess weight, I guess we really have a problem. I asked readers to share the stupidest remarks they have ever heard from a health professional about their weight -- the response was overwhelming.

It is perhaps time to consider public health discourse on whether or not any putative benefits from participation in organized sports are largely cancelled out by the ensuing time pressure that not only seriously cuts into time for healthy eating but also sleep and other activities that should be part of an overall healthy lifestyle.

To lose weight, you have to actually start moving down the escalator faster than it is moving up. Depending on how fast your personal escalator is moving up, the more effort this will take. The tricky part comes when the escalator starts speeding up as you make your way down.

It makes a lot of sense to first deal with what took you to the top before beginning your journey down that up-escalator. Clearly, simply jumping on that escalator without first dealing with the underlying problem will make losing weight and keeping it off so much more difficult -- remember, running down the escalator with no baggage is already hard enough.

One of the games I used to play as a kid was to run down the up escalator. To get to the bottom, I had to run down faster than the escalator was moving upwards. If I ran any slower, the escalator would take me back to the top. I use this analogy with my patients to help them understand the incredible challenge of losing weight and keeping it off.

Some readers may be well aware of the five stages of grief, the natural process of grieving, which, according to Kubler-Ross, move from denial to anger to fear to grief and finally to acceptance. Now that we have come to appreciate that obesity is a chronic disease, it should come as no surprise that these five stages also apply to obesity.

Recently I saw Betty* in my clinic. She is 44 years old and never had a "weight problem" till her eight-year-old only son met with a fatal road accident. That was 12 years ago. Since then she has steadily gained almost 10 pounds a year, which is why she is now 120 pounds heavier than she was at 32.

Let me explain: When I tell patients to stop smoking, they know exactly what to do, namely to stop putting a cigarette in their mouth and inhaling its smoke. That's a behaviour they can change. When they stop smoking they have "successfully" changed a behaviour -- that's behaviour change, end of story.

This week the wires were active with suggestions that people with obesity pay more for airline travel. The assumption underlying the "pay as you weigh" pricing strategies is that body size is a matter of choice and responsibility. Unfortunately, for most this is not the case.

When it comes to healthy living would you really want to give up something you enjoy? Or, even less likely, do you really want to start doing something you don't? Let us assume that there is now conclusive evidence that playing just 20 minutes of violin a day substantially reduces your risk of cancer, diabetes and heart disease. But now imagine that you happen to be someone who simply hates violin...

Though Toronto's mayor has lost 16 pounds in week two of his program, dieting only helps short-term. When treatment stops, the weight comes back -- always -- there are few (if any) known exceptions to this rule of nature. Cutting back calories and increasing activity addresses the symptoms of obesity -- not its causes.

To many readers, the very idea that you can carry excess weight and still be healthy may sound like an oxymoron. After all, is excess body fat not strongly associated with a wide range of health problems from diabetes to sleep apnea and from arthritis to cancer? Yes it is, but not in everyone.

If adult obesity is in fact the root cause of childhood obesity, then the only hope is to treat the parents. But weight gain in parents isn't always amenable to change. Dad's addiction to chips and pizza may simply be his way of coping with giving up cigarettes and alcohol.